Day/night variability in blood pressure: influence of posture and physical activity

Abstract

Background: Blood pressure (BP) is highest during the day and lowest at night. Absence of this rhythm is a predictor of cardiovascular morbidity and mortality. Contributions of changes in posture and physical activity to the 24-hour day/night rhythm in BP are not well understood. We hypothesized that postural changes and physical activity contribute substantially to the day/night rhythm in BP.

Methods: Fourteen healthy, sedentary, nonobese, normotensive men (aged 19-50 years) each completed an ambulatory and a bed rest condition during which BP was measured every 30-60 minutes for 24 hours. When ambulatory, subjects followed their usual routines without restrictions to capture the "normal" condition. During bed rest, subjects were constantly confined to bed in a 6-degree head-down position; therefore posture was constant, and physical activity was minimized. Two subjects were excluded from analysis because of irregular sleep timing.

Results: The systolic and diastolic BP reduction during the sleep period was similar in ambulatory (-11±2mmHg/-8±1mmHg) and bed rest conditions (-8±3mmHg/-4±2mmHg; P = 0.38/P = 0.12). The morning surge in diastolic BP was attenuated during bed rest (P = 0.001), and there was a statistical trend for the same effect in systolic BP (P = 0.06).

Conclusions: A substantial proportion of the 24-hour BP rhythm remained during bed rest, indicating that typical daily changes in posture and/or physical activity do not entirely explain 24-hour BP variation under normal ambulatory conditions. However, the morning BP increase was attenuated during bed rest, suggesting that the adoption of an upright posture and/or physical activity in the morning contributes to the morning BP surge.

Keywords: ambulatory; bed rest; blood pressure; circadian; hypertension; sleep..

Figure 1.

Blood pressure and heart rate measured during wake periods and sleep periods under ambulatory and bed rest conditions. (a) Systolic blood pressure (SBP) data. (b) Diastolic blood pressure (DBP) data. (c) Heart rate data. (d) Sleep period (SP)/wake period (WP)ratios. P values are given for comparison between ambulatory and bed rest trials. The additional data next to the P values indicates mean ± SEM difference between conditions.

Figure 2.

Twenty-four-hour blood pressure and heart rate profiles under ambulatory and bed rest conditions. (a and b) Systolic blood pressure (SBP) data. (c and d) Diastolic blood pressure (DBP) data. (e and f) Heart rate data. (a, c, e) Hourly plots of data (mean ± SEM). (b, d, f) Cosinor fits (mean ± 95% confidence interval). See text for P values.